Involving Clinicians in Guideline Development and Implementation

As discussed by the workshop participants, many clinicians do not view published guidelines as being applicable to their patients because those guidelines often come from research settings and academic centers believed to be different from typical community settings. Moreover, some clinical practice guidelines are not documented to be safe or effective, so clinicians are reluctant to accept them on faith. Because clinicians are busy and are increasingly required to meet productivity targets, they are reluctant to devote time to clinical practice guideline development.

Protected time and resources were discussed as essential needs of members of the medical community to become more knowledgeable on the latest medical advances in disease pathogenesis and current diagnosis and therapy, an important and integral component of maintaining high-quality medical care and adherence to guidelines. When hospitals and plans recognize that clinical practice guidelines will help make clinical care more effective and more cost-effective, they will be more likely to provide resources to help with the development of local guidelines.

The Need for Systemwide, Standardized Guidelines

Subscriber turnover and proprietary restrictions on access to managed care data, combined with the adoption of different clinical practice guidelines across managed care organizations, may compromise efforts to implement systemwide, standardized clinical practice guidelines. However, health care plan purchasers are in a good position to require health plans and hospitals to standardize the required guidelines and to reward those who comply with them.

Promoting Professional and Public Education

In addition to members of the health care profession, the public must also be better educated and informed about current information on disease states and treatments. Informed patients can encourage their doctors to use evidence-based best practices, which in turn can have a positive effect on clinicians.

Summary

A common thread throughout the discussion of clinical practice guidelines revolved around the extent to which managed care organizations should promote clinical practice guidelines. A common perception is that managed care fails to adhere to standardized clinical practice guidelines because many of these guidelines have not been validated under sustained clinical settings. Furthermore, it is



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